{ "resourceType": "Bundle", "id": "5723c4e6-a577-4e08-b422-0e0374117c68", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-31T14:15:41.024+03:00", "entry": [ { "fullUrl": "http://nphies.sa/MessageHeader/1c66949a-1022-4de9-b10c-75b57d33c0b1", "resource": { "resourceType": "MessageHeader", "id": "1c66949a-1022-4de9-b10c-75b57d33c0b1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ], "tag": [ { "system": "http://nphies.sa/terminology/CodeSystem/meta-tags", "code": "queued-messages" } ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "poll-response" }, "destination": [ { "endpoint": "http://nphies.sa/license/provider-license/10000300062591", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/nphies", "value": "NPHIES" } }, "source": { "endpoint": "http://nphies.sa/" }, "response": { "identifier": "b7793bc9-5467-44ab-9f72-ead7011cd34e", "code": "ok" } } }, { "fullUrl": "http://nphies.sa/Task/68b7ce1a-69d8-4b42-8896-2e150e3b4f8c", "resource": { "resourceType": "Task", "id": "68b7ce1a-69d8-4b42-8896-2e150e3b4f8c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/task|1.0.0" ], "tag": [ { "code": "NPHIES generated", "display": "NPHIES generated" } ] }, "identifier": [ { "system": "http://www.ALKholood.com/Task", "value": "538" } ], "status": "completed", "intent": "order", "priority": "stat", "code": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-code", "code": "poll" } ] }, "authoredOn": "2026-09-30", "lastModified": "2026-10-31", "requester": { "reference": "Organization/9" }, "owner": { "identifier": { "system": "http://nphies.sa/license/nphies", "value": "NPHIES" } }, "input": [ { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-input-type", "code": "include-message-type" } ] }, "valueCode": "claim-response" }, { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-input-type", "code": "period" } ] }, "valuePeriod": { "start": "2026-09-30T00:00:00.000+03:00", "end": "2026-10-31T23:59:59.999+03:00" } }, { "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/task-input-type", "code": "count" } ] }, "valuePositiveInt": 10 } ], "output": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.339+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/da520bf6-9bf9-4c9e-883c-7542e4aa3327" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.372+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/39360078-8ee9-478c-8058-f71145bd83de" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.402+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/bf84305c-6793-44ab-bdaf-11defd507944" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.407+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/1a20f8be-b81d-444a-9b70-b42a2ffb1fcc" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.447+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/0fe013b8-6709-4e8a-b440-b7e2db8aeeb6" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.519+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/4c1366bd-d84a-4464-8035-b2cc5acff2fa" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.528+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/190804dd-0149-484f-9513-bfa569478b04" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.546+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/62f52b8e-785e-4675-b535-ea023a1b9c98" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.563+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/4423e589-9de1-481e-bdd7-537f6baa0bf4" } }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-timestamp", "valueDateTime": "2026-10-20T08:55:18.573+00:00" } ], "type": { "coding": [ { "system": "http://nphies.sa/terminology/ValueSet/task-output-type", "code": "response" } ] }, "valueReference": { "reference": "http://nphies.sa/Bundle/b58cd28b-6dfd-4375-a585-d91a7b8b0d20" } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/da520bf6-9bf9-4c9e-883c-7542e4aa3327", "resource": { "resourceType": "Bundle", "id": "da520bf6-9bf9-4c9e-883c-7542e4aa3327", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:17.856+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/176ef932-6282-43ca-9543-8f635ab8e7d2", "resource": { "resourceType": "MessageHeader", "id": "176ef932-6282-43ca-9543-8f635ab8e7d2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "0012977f-809b-4660-92a9-543f38ca926e", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/97e8a9d1-e4f2-4cfa-b67e-a34b759c9ecb" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/97e8a9d1-e4f2-4cfa-b67e-a34b759c9ecb", "resource": { "resourceType": "ClaimResponse", "id": "97e8a9d1-e4f2-4cfa-b67e-a34b759c9ecb", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "partial" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1740" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "97e8a9d1-e4f2-4cfa-b67e-a34b759c9ecb" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/60a238d4-8815-44b7-9a57-3a7e0d869bff" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/1541f72a-2f9d-43f5-a418-b620fc7abc78" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/5ac798a3-146d-4825-82fb-44c0af66148f" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "87268031260921" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "93849" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 19.98, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 24.97, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 4.99, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 24.97, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "93849" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "CV-4-5" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "93849" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 21.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 17.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.59, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 4.31, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 21.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 53.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 37.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 10.7, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 53.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.59, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/bbb099e7-5916-4abb-adca-a4ccbe6aa29e" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/60a238d4-8815-44b7-9a57-3a7e0d869bff", "resource": { "resourceType": "Patient", "id": "60a238d4-8815-44b7-9a57-3a7e0d869bff", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2023140565" } ], "active": true, "name": [ { "use": "official", "text": "YASSER MOHAMMED ALI", "given": [ "YASSER", "ALI", "ALI" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1981-07-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/5ac798a3-146d-4825-82fb-44c0af66148f", "resource": { "resourceType": "Organization", "id": "5ac798a3-146d-4825-82fb-44c0af66148f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/1541f72a-2f9d-43f5-a418-b620fc7abc78", "resource": { "resourceType": "Organization", "id": "1541f72a-2f9d-43f5-a418-b620fc7abc78", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/bbb099e7-5916-4abb-adca-a4ccbe6aa29e", "resource": { "resourceType": "Coverage", "id": "bbb099e7-5916-4abb-adca-a4ccbe6aa29e", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002023140565001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/f3f17c0b-d780-479b-ad45-2a2b61bbf119" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/b81a9052-1128-474b-8314-a7122f27ab14" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/60a238d4-8815-44b7-9a57-3a7e0d869bff" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/1541f72a-2f9d-43f5-a418-b620fc7abc78" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "55413563", "name": "Rafada One Operation Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/f3f17c0b-d780-479b-ad45-2a2b61bbf119", "resource": { "resourceType": "Organization", "id": "f3f17c0b-d780-479b-ad45-2a2b61bbf119", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/b81a9052-1128-474b-8314-a7122f27ab14", "resource": { "resourceType": "Patient", "id": "b81a9052-1128-474b-8314-a7122f27ab14", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2023140565" } ], "active": true, "name": [ { "use": "official", "text": "YASSER MOHAMMED ALI", "given": [ "YASSER", "ALI", "ALI" ] } ], "telecom": [ { "system": "phone", "value": "0544484248" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1981-07-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/39360078-8ee9-478c-8058-f71145bd83de", "resource": { "resourceType": "Bundle", "id": "39360078-8ee9-478c-8058-f71145bd83de", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:17.716+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/ad090a69-7a83-48d0-9b45-9aef26747871", "resource": { "resourceType": "MessageHeader", "id": "ad090a69-7a83-48d0-9b45-9aef26747871", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "dc631c66-8f0f-4f71-9a93-d137efaa0989", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/ac160a9a-cfd3-4a33-bdf6-2e1df77cd70d" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/ac160a9a-cfd3-4a33-bdf6-2e1df77cd70d", "resource": { "resourceType": "ClaimResponse", "id": "ac160a9a-cfd3-4a33-bdf6-2e1df77cd70d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1907" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "ac160a9a-cfd3-4a33-bdf6-2e1df77cd70d" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/d8c7ba81-0886-42a9-b87f-91ab677beb68" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/a4a8ae52-dc0b-46df-8a27-0073e10ccd69" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/de9b6de9-f505-4e81-8c04-938533b3d89c" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "88272621260922" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "95496" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 13.36, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.67, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 13.36, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 10.69, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "95496" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.03, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "95496" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 17.53, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.45, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 17.53, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 13.12, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "95496" } } ], "itemSequence": 4, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 6.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 8.19, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 8.19, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 79.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 62.47, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 14.79, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 79.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/06e40efb-7a34-49c1-9c48-fce7148d3764" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d8c7ba81-0886-42a9-b87f-91ab677beb68", "resource": { "resourceType": "Patient", "id": "d8c7ba81-0886-42a9-b87f-91ab677beb68", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2540051964" } ], "active": true, "name": [ { "use": "official", "text": "MMED ALIEM MEEAH SULTAN", "given": [ "MMED", "MEEAH", "SULTAN" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2000-01-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/de9b6de9-f505-4e81-8c04-938533b3d89c", "resource": { "resourceType": "Organization", "id": "de9b6de9-f505-4e81-8c04-938533b3d89c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a4a8ae52-dc0b-46df-8a27-0073e10ccd69", "resource": { "resourceType": "Organization", "id": "a4a8ae52-dc0b-46df-8a27-0073e10ccd69", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/06e40efb-7a34-49c1-9c48-fce7148d3764", "resource": { "resourceType": "Coverage", "id": "06e40efb-7a34-49c1-9c48-fce7148d3764", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002540051964001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/97be4acb-fb31-4c18-80af-6f3c2923f6d1" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/d89cee6f-eefa-4721-a804-6bf38d69bd92" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/d8c7ba81-0886-42a9-b87f-91ab677beb68" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/a4a8ae52-dc0b-46df-8a27-0073e10ccd69" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "53344656", "name": "Rabie Shaher Al Gham Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/97be4acb-fb31-4c18-80af-6f3c2923f6d1", "resource": { "resourceType": "Organization", "id": "97be4acb-fb31-4c18-80af-6f3c2923f6d1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/d89cee6f-eefa-4721-a804-6bf38d69bd92", "resource": { "resourceType": "Patient", "id": "d89cee6f-eefa-4721-a804-6bf38d69bd92", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2540051964" } ], "active": true, "name": [ { "use": "official", "text": "MMED ALIEM MEEAH SULTAN", "given": [ "MMED", "MEEAH", "SULTAN" ] } ], "telecom": [ { "system": "phone", "value": "0529823676" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "2000-01-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/bf84305c-6793-44ab-bdaf-11defd507944", "resource": { "resourceType": "Bundle", "id": "bf84305c-6793-44ab-bdaf-11defd507944", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:17.810+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/20831bb7-f3ca-4e4f-8c36-514654271eb4", "resource": { "resourceType": "MessageHeader", "id": "20831bb7-f3ca-4e4f-8c36-514654271eb4", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "db3755d9-f849-4d6f-a03f-fca26db2dcf3", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/d6b44456-5ae9-4529-a8a5-72262ff9c216" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/d6b44456-5ae9-4529-a8a5-72262ff9c216", "resource": { "resourceType": "ClaimResponse", "id": "d6b44456-5ae9-4529-a8a5-72262ff9c216", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1981" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "d6b44456-5ae9-4529-a8a5-72262ff9c216" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/296c7cd7-4798-4f8e-aefb-3e6c553c1bfc" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/a1e864b6-1a08-47b1-966a-4bd2e5410f9d" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/8d5b3266-2ea5-437d-987c-3c01952c4779" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "69274772260923" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "96259" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.03, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "96259" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 17.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 3.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 17.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 14.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.13, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "96259" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 8.19, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 6.55, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.64, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 8.19, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 66.1, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 52.88, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 13.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 66.1, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 2.13, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/bf2407d0-13b5-4f05-a40a-8924691c4767" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/296c7cd7-4798-4f8e-aefb-3e6c553c1bfc", "resource": { "resourceType": "Patient", "id": "296c7cd7-4798-4f8e-aefb-3e6c553c1bfc", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2270585603" } ], "active": true, "name": [ { "use": "official", "text": "MONEER AHMED ahmed ABDULWALI", "given": [ "MONEER", "ahmed", "ABDULWALI" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1973-02-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/8d5b3266-2ea5-437d-987c-3c01952c4779", "resource": { "resourceType": "Organization", "id": "8d5b3266-2ea5-437d-987c-3c01952c4779", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a1e864b6-1a08-47b1-966a-4bd2e5410f9d", "resource": { "resourceType": "Organization", "id": "a1e864b6-1a08-47b1-966a-4bd2e5410f9d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/bf2407d0-13b5-4f05-a40a-8924691c4767", "resource": { "resourceType": "Coverage", "id": "bf2407d0-13b5-4f05-a40a-8924691c4767", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002270585603001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/830c4cbe-caea-44cd-b167-78955bb0aa4a" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/4d210b7c-0877-42a1-ad67-d053603d8a07" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/296c7cd7-4798-4f8e-aefb-3e6c553c1bfc" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/a1e864b6-1a08-47b1-966a-4bd2e5410f9d" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "48655111", "name": "FAWAHHA ALKHALIJ COM Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/830c4cbe-caea-44cd-b167-78955bb0aa4a", "resource": { "resourceType": "Organization", "id": "830c4cbe-caea-44cd-b167-78955bb0aa4a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/4d210b7c-0877-42a1-ad67-d053603d8a07", "resource": { "resourceType": "Patient", "id": "4d210b7c-0877-42a1-ad67-d053603d8a07", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2270585603" } ], "active": true, "name": [ { "use": "official", "text": "MONEER AHMED ahmed ABDULWALI", "given": [ "MONEER", "ahmed", "ABDULWALI" ] } ], "telecom": [ { "system": "phone", "value": "0550331510" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1973-02-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/1a20f8be-b81d-444a-9b70-b42a2ffb1fcc", "resource": { "resourceType": "Bundle", "id": "1a20f8be-b81d-444a-9b70-b42a2ffb1fcc", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:16.467+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/e6c5d585-1d99-476b-819d-50ee6ae4b5ae", "resource": { "resourceType": "MessageHeader", "id": "e6c5d585-1d99-476b-819d-50ee6ae4b5ae", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "33e013c6-0c6c-4f5a-b003-32e2c855c611", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/b7d2d543-7d97-4584-a796-b2eb46bb25b8" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/b7d2d543-7d97-4584-a796-b2eb46bb25b8", "resource": { "resourceType": "ClaimResponse", "id": "b7d2d543-7d97-4584-a796-b2eb46bb25b8", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1811" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "b7d2d543-7d97-4584-a796-b2eb46bb25b8" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/8ffd6a5c-de1a-4316-a0f3-d1e2f8c73295" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/74da8142-38ba-4666-8c4b-06a8fe1c01bc" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/a4c37239-2e58-4ba0-bd96-8dd59e5e32b6" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "51269714260921" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "94434" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.03, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.03, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.14, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/86e8d61b-5856-427b-b8fa-5d014d6530f0" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/8ffd6a5c-de1a-4316-a0f3-d1e2f8c73295", "resource": { "resourceType": "Patient", "id": "8ffd6a5c-de1a-4316-a0f3-d1e2f8c73295", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2521756938" } ], "active": true, "name": [ { "use": "official", "text": "GHALAM ALI muhammad", "given": [ "GHALAM", "ALI", "muhammad" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1998-01-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a4c37239-2e58-4ba0-bd96-8dd59e5e32b6", "resource": { "resourceType": "Organization", "id": "a4c37239-2e58-4ba0-bd96-8dd59e5e32b6", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/74da8142-38ba-4666-8c4b-06a8fe1c01bc", "resource": { "resourceType": "Organization", "id": "74da8142-38ba-4666-8c4b-06a8fe1c01bc", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/86e8d61b-5856-427b-b8fa-5d014d6530f0", "resource": { "resourceType": "Coverage", "id": "86e8d61b-5856-427b-b8fa-5d014d6530f0", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002521756938001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/f5a558f0-9288-48c2-b870-e495d56af494" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/dcdbf43b-563e-40bb-919b-a8c4126466fe" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/8ffd6a5c-de1a-4316-a0f3-d1e2f8c73295" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/74da8142-38ba-4666-8c4b-06a8fe1c01bc" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "53384398", "name": "AlFikr AlSaid Contra Bronze B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/f5a558f0-9288-48c2-b870-e495d56af494", "resource": { "resourceType": "Organization", "id": "f5a558f0-9288-48c2-b870-e495d56af494", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/dcdbf43b-563e-40bb-919b-a8c4126466fe", "resource": { "resourceType": "Patient", "id": "dcdbf43b-563e-40bb-919b-a8c4126466fe", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2521756938" } ], "active": true, "name": [ { "use": "official", "text": "GHALAM ALI muhammad", "given": [ "GHALAM", "ALI", "muhammad" ] } ], "telecom": [ { "system": "phone", "value": "0546741696" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1998-01-01", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/0fe013b8-6709-4e8a-b440-b7e2db8aeeb6", "resource": { "resourceType": "Bundle", "id": "0fe013b8-6709-4e8a-b440-b7e2db8aeeb6", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:16.825+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/2e02f6a7-6860-47ba-9852-12ce7543833d", "resource": { "resourceType": "MessageHeader", "id": "2e02f6a7-6860-47ba-9852-12ce7543833d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "87227c11-50ef-441f-a9cf-7a58ee5cb010", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/33bb23af-7192-44d6-b1c2-65d0ea98042e" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/33bb23af-7192-44d6-b1c2-65d0ea98042e", "resource": { "resourceType": "ClaimResponse", "id": "33bb23af-7192-44d6-b1c2-65d0ea98042e", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2484" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "33bb23af-7192-44d6-b1c2-65d0ea98042e" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/857fa775-042d-490e-833a-52fc0b2ffbc0" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/4d912f52-264b-48e7-bfa7-7fb6b3e5fb69" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/705befb3-cdbb-4a00-bffb-d4e91790e57a" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "14289176260928" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "101617" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 4.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 4.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 4.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "101617" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 45, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 45, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 45, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "101617" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.96, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.96, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 7.96, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "101617" } } ], "itemSequence": 4, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 9.63, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 9.63, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 9.63, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "101617" } } ], "itemSequence": 5, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 30.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 30.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 30.6, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 97.73, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 97.73, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 97.73, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/11a4e0e9-2bf0-4f7d-8deb-0cdc9b9a4ec4" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/857fa775-042d-490e-833a-52fc0b2ffbc0", "resource": { "resourceType": "Patient", "id": "857fa775-042d-490e-833a-52fc0b2ffbc0", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2410204123" } ], "active": true, "name": [ { "use": "official", "text": "KHALID osama hasan", "given": [ "KHALID", "osama", "hasan" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1990-04-02", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/705befb3-cdbb-4a00-bffb-d4e91790e57a", "resource": { "resourceType": "Organization", "id": "705befb3-cdbb-4a00-bffb-d4e91790e57a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/4d912f52-264b-48e7-bfa7-7fb6b3e5fb69", "resource": { "resourceType": "Organization", "id": "4d912f52-264b-48e7-bfa7-7fb6b3e5fb69", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/11a4e0e9-2bf0-4f7d-8deb-0cdc9b9a4ec4", "resource": { "resourceType": "Coverage", "id": "11a4e0e9-2bf0-4f7d-8deb-0cdc9b9a4ec4", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002410204123001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/446bb9f2-13fd-4576-a70e-a274cae0ef60" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/9bab5220-032c-4fa2-8e83-95c8181fdbe8" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/857fa775-042d-490e-833a-52fc0b2ffbc0" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/4d912f52-264b-48e7-bfa7-7fb6b3e5fb69" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54859778", "name": "SUPPLIES SUMMIT FOR TRADING" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/446bb9f2-13fd-4576-a70e-a274cae0ef60", "resource": { "resourceType": "Organization", "id": "446bb9f2-13fd-4576-a70e-a274cae0ef60", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/9bab5220-032c-4fa2-8e83-95c8181fdbe8", "resource": { "resourceType": "Patient", "id": "9bab5220-032c-4fa2-8e83-95c8181fdbe8", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2410204123" } ], "active": true, "name": [ { "use": "official", "text": "KHALID osama hasan", "given": [ "KHALID", "osama", "hasan" ] } ], "telecom": [ { "system": "phone", "value": "0547293163" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1990-04-02", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/4c1366bd-d84a-4464-8035-b2cc5acff2fa", "resource": { "resourceType": "Bundle", "id": "4c1366bd-d84a-4464-8035-b2cc5acff2fa", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:18.003+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/a7c985d4-8179-407a-ba17-d2e678b62772", "resource": { "resourceType": "MessageHeader", "id": "a7c985d4-8179-407a-ba17-d2e678b62772", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "ae39eaaf-5793-4eba-bce8-b791321b0828", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/259600f9-ecde-485b-a1e0-7027a9141179" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/259600f9-ecde-485b-a1e0-7027a9141179", "resource": { "resourceType": "ClaimResponse", "id": "259600f9-ecde-485b-a1e0-7027a9141179", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2660" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "259600f9-ecde-485b-a1e0-7027a9141179" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/2ab429bf-c6bf-40b7-b12b-812fbb9f5e59" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/b35648eb-81b6-48ba-b0b9-b599ea991dcd" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/45a8c9bf-0269-4ef6-86ce-7e3b79560559" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "41294344260930" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "103350" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 26.59, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 5.32, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 26.59, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 21.27, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "103350" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 10.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 10.3, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 8.24, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.06, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "103350" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 8.41, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.68, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 8.41, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 6.73, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "103350" } } ], "itemSequence": 4, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 9.61, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 12.01, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 12.01, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 57.31, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 45.85, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 11.46, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 57.31, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/e8e655dd-77d2-4aa3-a328-b2ed22147897" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/2ab429bf-c6bf-40b7-b12b-812fbb9f5e59", "resource": { "resourceType": "Patient", "id": "2ab429bf-c6bf-40b7-b12b-812fbb9f5e59", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2604591525" } ], "active": true, "name": [ { "use": "official", "text": "MNNA WALID KAMEL ALI", "given": [ "MNNA", "KAMEL", "ALI" ] } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "2023-12-17", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/45a8c9bf-0269-4ef6-86ce-7e3b79560559", "resource": { "resourceType": "Organization", "id": "45a8c9bf-0269-4ef6-86ce-7e3b79560559", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/b35648eb-81b6-48ba-b0b9-b599ea991dcd", "resource": { "resourceType": "Organization", "id": "b35648eb-81b6-48ba-b0b9-b599ea991dcd", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/e8e655dd-77d2-4aa3-a328-b2ed22147897", "resource": { "resourceType": "Coverage", "id": "e8e655dd-77d2-4aa3-a328-b2ed22147897", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002327170128221" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/da25a8bf-8d25-4dc1-904f-3d2468e7647f" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/516885d7-bdd9-4d27-94de-86d661eac0d1" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/2ab429bf-c6bf-40b7-b12b-812fbb9f5e59" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/b35648eb-81b6-48ba-b0b9-b599ea991dcd" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54643652", "name": "HATEM MAHMOUD SINDI EST Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/da25a8bf-8d25-4dc1-904f-3d2468e7647f", "resource": { "resourceType": "Organization", "id": "da25a8bf-8d25-4dc1-904f-3d2468e7647f", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/516885d7-bdd9-4d27-94de-86d661eac0d1", "resource": { "resourceType": "Patient", "id": "516885d7-bdd9-4d27-94de-86d661eac0d1", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2604591525" } ], "active": true, "name": [ { "use": "official", "text": "MNNA WALID KAMEL ALI", "given": [ "MNNA", "KAMEL", "ALI" ] } ], "telecom": [ { "system": "phone", "value": "0534565645" } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "2023-12-17", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/190804dd-0149-484f-9513-bfa569478b04", "resource": { "resourceType": "Bundle", "id": "190804dd-0149-484f-9513-bfa569478b04", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:16.477+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/5a9dc0d1-ee9e-4c33-94dc-6410fd35bc32", "resource": { "resourceType": "MessageHeader", "id": "5a9dc0d1-ee9e-4c33-94dc-6410fd35bc32", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "280bc1ff-4479-474b-a286-7838e2af5c07", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/812e262c-30df-4b38-9559-4c10cb6bdfb2" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/812e262c-30df-4b38-9559-4c10cb6bdfb2", "resource": { "resourceType": "ClaimResponse", "id": "812e262c-30df-4b38-9559-4c10cb6bdfb2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "partial" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1503" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "812e262c-30df-4b38-9559-4c10cb6bdfb2" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/c6552ff4-cd58-45e8-9f9c-a55a313d44e7" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/4d98bd1e-7141-4105-b89c-8e9f9ff58d9a" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/71ffa2e0-7ffa-48b0-9ac4-e8fa2d617ef3" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "87261393260918" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "91212" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 25.13, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 31.41, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 6.28, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 31.41, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "rejected" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "91212" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 11.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 11.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "reason": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-reason", "code": "MN-1-1" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 0 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "91212" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 52.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 41.62, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 10.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 52.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 94.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 66.75, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 18.9, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 94.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/b411a0de-2a2f-406e-ba2c-6f1488642d9c" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/c6552ff4-cd58-45e8-9f9c-a55a313d44e7", "resource": { "resourceType": "Patient", "id": "c6552ff4-cd58-45e8-9f9c-a55a313d44e7", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1049226200" } ], "active": true, "name": [ { "use": "official", "text": "MAHA AHMED muhammad al-masry", "given": [ "MAHA", "muhammad", "al-masry" ] } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "1968-07-26", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/71ffa2e0-7ffa-48b0-9ac4-e8fa2d617ef3", "resource": { "resourceType": "Organization", "id": "71ffa2e0-7ffa-48b0-9ac4-e8fa2d617ef3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/4d98bd1e-7141-4105-b89c-8e9f9ff58d9a", "resource": { "resourceType": "Organization", "id": "4d98bd1e-7141-4105-b89c-8e9f9ff58d9a", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/b411a0de-2a2f-406e-ba2c-6f1488642d9c", "resource": { "resourceType": "Coverage", "id": "b411a0de-2a2f-406e-ba2c-6f1488642d9c", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "001066615673511" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/9f09782e-f15a-4eb1-ba7e-3f8cc10634d3" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/64517bec-7dd8-4815-83e2-c49c641250cf" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/c6552ff4-cd58-45e8-9f9c-a55a313d44e7" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/4d98bd1e-7141-4105-b89c-8e9f9ff58d9a" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "56651214", "name": "SAUDI GROUND SERVICES CO" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/9f09782e-f15a-4eb1-ba7e-3f8cc10634d3", "resource": { "resourceType": "Organization", "id": "9f09782e-f15a-4eb1-ba7e-3f8cc10634d3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/64517bec-7dd8-4815-83e2-c49c641250cf", "resource": { "resourceType": "Patient", "id": "64517bec-7dd8-4815-83e2-c49c641250cf", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "NI", "display": "National ID" } ] }, "system": "http://nphies.sa/identifier/nationalid", "value": "1049226200" } ], "active": true, "name": [ { "use": "official", "text": "MAHA AHMED muhammad al-masry", "given": [ "MAHA", "muhammad", "al-masry" ] } ], "telecom": [ { "system": "phone", "value": "0505655731" } ], "gender": "female", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "female", "display": "female" } ] } } ] }, "birthDate": "1968-07-26", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/62f52b8e-785e-4675-b535-ea023a1b9c98", "resource": { "resourceType": "Bundle", "id": "62f52b8e-785e-4675-b535-ea023a1b9c98", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:17.666+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/d5a6cf58-76c0-45ca-9d0e-58f241ac13fb", "resource": { "resourceType": "MessageHeader", "id": "d5a6cf58-76c0-45ca-9d0e-58f241ac13fb", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "f61c8203-b463-49a9-a285-8c3296ff4a38", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/3fe77a11-c727-4a0d-a651-7b5314d625b2" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/3fe77a11-c727-4a0d-a651-7b5314d625b2", "resource": { "resourceType": "ClaimResponse", "id": "3fe77a11-c727-4a0d-a651-7b5314d625b2", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1956" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "3fe77a11-c727-4a0d-a651-7b5314d625b2" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/5352e719-6077-45b8-bb65-08e96ab75a14" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/b630f171-f13b-4654-b408-8bdb0208d417" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/60b56cd2-09ec-4d62-9de5-0351863238fb" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "44273990260923" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "95982" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 25.85, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 32.31, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 32.31, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 6.46, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "95982" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.62, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.4, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 7.02, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 39.33, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 31.47, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 7.86, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 39.33, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/8d3edd8f-a9fc-4256-b17d-45e613417e58" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/5352e719-6077-45b8-bb65-08e96ab75a14", "resource": { "resourceType": "Patient", "id": "5352e719-6077-45b8-bb65-08e96ab75a14", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2475057713" } ], "active": true, "name": [ { "use": "official", "text": "MD CHANE MIA MD", "given": [ "MD", "MIA", "MD" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1985-05-02", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/60b56cd2-09ec-4d62-9de5-0351863238fb", "resource": { "resourceType": "Organization", "id": "60b56cd2-09ec-4d62-9de5-0351863238fb", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/b630f171-f13b-4654-b408-8bdb0208d417", "resource": { "resourceType": "Organization", "id": "b630f171-f13b-4654-b408-8bdb0208d417", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/8d3edd8f-a9fc-4256-b17d-45e613417e58", "resource": { "resourceType": "Coverage", "id": "8d3edd8f-a9fc-4256-b17d-45e613417e58", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002475057713001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/1e2e33d6-c616-4f0f-a833-df18c65c4926" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/52d34cde-9fea-4065-96e2-db8c6426b472" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/5352e719-6077-45b8-bb65-08e96ab75a14" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/b630f171-f13b-4654-b408-8bdb0208d417" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "53176842", "name": "POWER AND WATER TECHNOLOGY AWPT" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/1e2e33d6-c616-4f0f-a833-df18c65c4926", "resource": { "resourceType": "Organization", "id": "1e2e33d6-c616-4f0f-a833-df18c65c4926", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/52d34cde-9fea-4065-96e2-db8c6426b472", "resource": { "resourceType": "Patient", "id": "52d34cde-9fea-4065-96e2-db8c6426b472", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2475057713" } ], "active": true, "name": [ { "use": "official", "text": "MD CHANE MIA MD", "given": [ "MD", "MIA", "MD" ] } ], "telecom": [ { "system": "phone", "value": "0592569758" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1985-05-02", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/4423e589-9de1-481e-bdd7-537f6baa0bf4", "resource": { "resourceType": "Bundle", "id": "4423e589-9de1-481e-bdd7-537f6baa0bf4", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:18.255+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/46e16f3f-5e7d-4a88-9c5e-63d152c031ad", "resource": { "resourceType": "MessageHeader", "id": "46e16f3f-5e7d-4a88-9c5e-63d152c031ad", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "058721b6-4faf-48cf-a09b-9da05d5cd672", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/d269a38d-49c8-4bde-b0b3-e94dbd5b2c66" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/d269a38d-49c8-4bde-b0b3-e94dbd5b2c66", "resource": { "resourceType": "ClaimResponse", "id": "d269a38d-49c8-4bde-b0b3-e94dbd5b2c66", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "1099" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "d269a38d-49c8-4bde-b0b3-e94dbd5b2c66" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/fd13f40f-c62d-4618-af33-2fbb7e181558" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/73d65654-1c86-4d7d-a0c5-dc01d6ff6956" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/7a49b5fb-5599-4d29-8c28-d031ff680702" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "9250052260914" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "86881" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 32.62, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 40.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 8.15, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 40.77, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "86881" } } ], "itemSequence": 2, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 6.35, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.13, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 6.35, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 4.54, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] }, { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "86881" } } ], "itemSequence": 3, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 11.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 8.89, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 2.22, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 11.11, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 58.23, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 46.05, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 11.5, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 58.23, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/27fe8831-ce7b-4ff0-bd6c-051657462331" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/fd13f40f-c62d-4618-af33-2fbb7e181558", "resource": { "resourceType": "Patient", "id": "fd13f40f-c62d-4618-af33-2fbb7e181558", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2282509096" } ], "active": true, "name": [ { "use": "official", "text": "ayman muhammad muhammad ALI", "given": [ "ayman", "muhammad", "ALI" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1988-12-10", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "U" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/7a49b5fb-5599-4d29-8c28-d031ff680702", "resource": { "resourceType": "Organization", "id": "7a49b5fb-5599-4d29-8c28-d031ff680702", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/73d65654-1c86-4d7d-a0c5-dc01d6ff6956", "resource": { "resourceType": "Organization", "id": "73d65654-1c86-4d7d-a0c5-dc01d6ff6956", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/27fe8831-ce7b-4ff0-bd6c-051657462331", "resource": { "resourceType": "Coverage", "id": "27fe8831-ce7b-4ff0-bd6c-051657462331", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002282509096001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/6f5f1ff2-35f0-4e07-a3e5-0e5906ecbd54" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/12d65490-087c-4351-a32b-a3f8a75d2798" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/fd13f40f-c62d-4618-af33-2fbb7e181558" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/73d65654-1c86-4d7d-a0c5-dc01d6ff6956" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54510382", "name": "Golden Land Real Est Basic B" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/6f5f1ff2-35f0-4e07-a3e5-0e5906ecbd54", "resource": { "resourceType": "Organization", "id": "6f5f1ff2-35f0-4e07-a3e5-0e5906ecbd54", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/12d65490-087c-4351-a32b-a3f8a75d2798", "resource": { "resourceType": "Patient", "id": "12d65490-087c-4351-a32b-a3f8a75d2798", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2282509096" } ], "active": true, "name": [ { "use": "official", "text": "ayman muhammad muhammad ALI", "given": [ "ayman", "muhammad", "ALI" ] } ], "telecom": [ { "system": "phone", "value": "0507641990" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1988-12-10", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://nphies.sa/Bundle/b58cd28b-6dfd-4375-a585-d91a7b8b0d20", "resource": { "resourceType": "Bundle", "id": "b58cd28b-6dfd-4375-a585-d91a7b8b0d20", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/bundle|1.0.0" ] }, "type": "message", "timestamp": "2026-10-20T11:55:17.739+03:00", "entry": [ { "fullUrl": "https://tawuniya.com.sa/MessageHeader/81b594c9-fcd7-4452-9b7d-b4091090fe29", "resource": { "resourceType": "MessageHeader", "id": "81b594c9-fcd7-4452-9b7d-b4091090fe29", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/message-header|1.0.0" ] }, "eventCoding": { "system": "http://nphies.sa/terminology/CodeSystem/ksa-message-events", "code": "claim-response" }, "destination": [ { "endpoint": "http://www.ALKholood.com", "receiver": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } } } ], "sender": { "type": "Organization", "identifier": { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } }, "source": { "endpoint": "https://tawuniya.com.sa" }, "response": { "identifier": "4c0cdf7d-4199-4db9-b6f0-b86af3d68009", "code": "ok" }, "focus": [ { "reference": "https://tawuniya.com.sa/ClaimResponse/5b082911-6e64-4665-b6dd-848355fe5044" } ] } }, { "fullUrl": "https://tawuniya.com.sa/ClaimResponse/5b082911-6e64-4665-b6dd-848355fe5044", "resource": { "resourceType": "ClaimResponse", "id": "5b082911-6e64-4665-b6dd-848355fe5044", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/prior-auth-response|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-reissue", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/reissue-reason", "code": "adjudication" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-batch-identifier", "valueIdentifier": { "system": "http://www.ALKholood.com/episode", "value": "2070" } } ], "identifier": [ { "system": "https://tawuniya.com.sa/claimResponse", "value": "5b082911-6e64-4665-b6dd-848355fe5044" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "pharmacy" } ] }, "subType": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/claim-subtype", "code": "op" } ] }, "use": "claim", "patient": { "reference": "https://tawuniya.com.sa/Patient/0d067402-29ec-46af-a2f5-938bdcf732f3" }, "created": "2026-10-20", "insurer": { "reference": "https://tawuniya.com.sa/Organization/5ebd7e01-906c-43b4-a046-7a2c3ada2e5d" }, "requestor": { "reference": "https://tawuniya.com.sa/Organization/2f76e6ca-19cf-494f-88cb-4e9fcebb32ac" }, "request": { "identifier": { "system": "http://www.ALKholood.com/claim", "value": "99276989260924" } }, "outcome": "complete", "disposition": "-", "item": [ { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-adjudication-outcome", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/adjudication-outcome", "code": "approved" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patientInvoice", "valueIdentifier": { "system": "http://www.ALKholood.com/patientInvoice", "value": "97211" } } ], "itemSequence": 1, "adjudication": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 6.84, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.37, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.47, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 6.84, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-adjudication", "code": "approved-quantity" } ] }, "value": 1 } ] } ], "total": [ { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "submitted" } ] }, "amount": { "value": 6.84, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "benefit" } ] }, "amount": { "value": 5.47, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "deductible" } ] }, "amount": { "value": 0, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "copay" } ] }, "amount": { "value": 1.37, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "eligible" } ] }, "amount": { "value": 6.84, "currency": "SAR" } }, { "category": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/adjudication", "code": "tax" } ] }, "amount": { "value": 0, "currency": "SAR" } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "https://tawuniya.com.sa/Coverage/7e118333-c3d4-4e0a-9cfa-6865e5a29464" } } ] } }, { "fullUrl": "https://tawuniya.com.sa/Patient/0d067402-29ec-46af-a2f5-938bdcf732f3", "resource": { "resourceType": "Patient", "id": "0d067402-29ec-46af-a2f5-938bdcf732f3", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2255706190" } ], "active": true, "name": [ { "use": "official", "text": "SAAD SHUQEE ABBED AMNG", "given": [ "SAAD", "ABBED", "AMNG" ] } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1982-01-13", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } }, { "fullUrl": "https://tawuniya.com.sa/Organization/2f76e6ca-19cf-494f-88cb-4e9fcebb32ac", "resource": { "resourceType": "Organization", "id": "2f76e6ca-19cf-494f-88cb-4e9fcebb32ac", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } }, { "fullUrl": "https://tawuniya.com.sa/Organization/5ebd7e01-906c-43b4-a046-7a2c3ada2e5d", "resource": { "resourceType": "Organization", "id": "5ebd7e01-906c-43b4-a046-7a2c3ada2e5d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/insurer-organization|1.0.0" ] }, "identifier": [ { "system": "http://nphies.sa/license/payer-license", "value": "7000911508" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "ins" } ] } ], "name": "The Cooperative Company for Cooperative Insurance" } }, { "fullUrl": "https://tawuniya.com.sa/Coverage/7e118333-c3d4-4e0a-9cfa-6865e5a29464", "resource": { "resourceType": "Coverage", "id": "7e118333-c3d4-4e0a-9cfa-6865e5a29464", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/coverage|1.0.0" ] }, "identifier": [ { "system": "https://tawuniya.com.sa/memberid", "value": "002255706190001" } ], "status": "active", "type": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/coverage-type", "code": "EHCPOL" } ] }, "policyHolder": { "reference": "https://tawuniya.com.sa/Organization/a5f83d76-a4d8-49f4-8f8e-7db61f20a05d" }, "subscriber": { "reference": "https://tawuniya.com.sa/Patient/f5975adc-3328-4c52-aaec-9d8349fd0e24" }, "beneficiary": { "reference": "https://tawuniya.com.sa/Patient/0d067402-29ec-46af-a2f5-938bdcf732f3" }, "relationship": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code": "self", "display": "self" } ] }, "payor": [ { "reference": "https://tawuniya.com.sa/Organization/5ebd7e01-906c-43b4-a046-7a2c3ada2e5d" } ], "class": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/coverage-class", "code": "plan" } ] }, "value": "54720160", "name": "DECISIVE STORM CONTRACTING EST Basic" } ] } }, { "fullUrl": "https://tawuniya.com.sa/Organization/a5f83d76-a4d8-49f4-8f8e-7db61f20a05d", "resource": { "resourceType": "Organization", "id": "a5f83d76-a4d8-49f4-8f8e-7db61f20a05d", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/policyholder-organization|1.0.0" ] }, "active": true, "name": "Policy Holder" } }, { "fullUrl": "https://tawuniya.com.sa/Patient/f5975adc-3328-4c52-aaec-9d8349fd0e24", "resource": { "resourceType": "Patient", "id": "f5975adc-3328-4c52-aaec-9d8349fd0e24", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/patient|1.0.0" ] }, "extension": [ { "url": "https://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-nationality", "valueCodeableConcept": { "coding": [ { "system": "https://nphies.sa/terminology/CodeSystem/nationality", "code": "PAK" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-patient-religion", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/religion", "code": "0", "display": "other" } ] } }, { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-occupation", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/occupation", "code": "others", "display": "others" } ] } } ], "identifier": [ { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v2-0203", "code": "PRC", "display": "iqama" } ] }, "system": "http://nphies.sa/identifier/iqama", "value": "2255706190" } ], "active": true, "name": [ { "use": "official", "text": "SAAD SHUQEE ABBED AMNG", "given": [ "SAAD", "ABBED", "AMNG" ] } ], "telecom": [ { "system": "phone", "value": "0564950595" } ], "gender": "male", "_gender": { "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-ksa-administrative-gender", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/ksa-administrative-gender", "code": "male", "display": "male" } ] } } ] }, "birthDate": "1982-01-13", "maritalStatus": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus", "code": "M" } ] } } } ] } }, { "fullUrl": "http://www.ALKholood.com/Organization/9", "resource": { "resourceType": "Organization", "id": "9", "meta": { "profile": [ "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/provider-organization|1.0.0" ] }, "extension": [ { "url": "http://nphies.sa/fhir/ksa/nphies-fs/StructureDefinition/extension-provider-type", "valueCodeableConcept": { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/provider-type", "code": "5", "display": "Clinic" } ] } } ], "identifier": [ { "use": "official", "system": "http://nphies.sa/license/provider-license", "value": "10000300062591" } ], "active": true, "type": [ { "coding": [ { "system": "http://nphies.sa/terminology/CodeSystem/organization-type", "code": "prov" } ] } ], "name": "Al-Kholood Medical Company - AlHaj" } } ] }